Healthcare Provider Details

I. General information

NPI: 1164945325
Provider Name (Legal Business Name): XIAOFEI LIU LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 THAIN RD
LEWISTON ID
83501
US

IV. Provider business mailing address

234 THAIN RD
LEWISTON ID
83501
US

V. Phone/Fax

Practice location:
  • Phone: 208-791-5837
  • Fax:
Mailing address:
  • Phone: 208-791-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-2801
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: